What is This Liver Tumor?

Laisa Socorro Briongos-Figuero and Tomás Zamora-Martínez describe the case of a 59-year-old man with chronic pancreatitis who was was admitted to the hospital with vomiting and jaundice, without fever or diarrhea. He had a previous history of cachexia, recurrent vomiting, and malnutrition related to cholecystectomy and a Roux-en-Y gastric bypass more than 10 years ago.

He was a former drinker without a history of chemical or radiation exposure, and no other comorbidities.

Percutaneous computerized tomography-guided biopsy revealed a hepatic epithelioid hemangioendothelioma (HEH) that was positive for the markers CD31 and CD34, and reacted with the monoclonal antibody D2-40, indicating a vascular endothelial origin. No metastases were detected.

Briongos-Figuero and Zamora-Martínez explain that HEH is a rare liver tumor of vascular origin with an incidence of less than 0.1 per 100,000 individuals. It has an unpredictable course that ranges from benign hemangioma to angiosarcoma.

Briongos-Figuero and Zamora-Martínez say that findings from computed tomography can include multiple lesions or a large peripherally hypodense mass, peripheral enhancement of contrast, and hypervascularized lesions. Magnetic resonance imaging shows a hypo-intense mass on T1-weighted, and a hyperintense mass on T2-weighted, images. Ascites and portal hypertension rarely are observed, but extra-hepatic metastasis are frequent.

Surgical resection and liver transplantation are the most common treatments for HEH, which seems to be resistant to chemotherapy and radiotherapy.

The patient of Briongos-Figuero and Zamora-Martínez could not undergo liver resection or transplantation because of his deteriorated physical state, the size of his tumor, and his risk for acute liver failure. He was treated with thalidomide but suddenly developed severe hematemesis; he died 4 weeks after the start of therapy.

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About the Author

Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology. She has worked as an editor at biomedical research journals and as a science writer for 15 years, covering advances in gastroenterology, hepatology, cancer, immunology, biotechnology, molecular genetics, and clinical trials. She has a PhD in cell biology and an interest in all areas of medical research.